The Alcoholic Whose Dog Had Died

 


A 58 year old white golf caddy was brought to the ER because of a "blackout". The day of admission, he had a shot of whiskey and three beers with his breakfast and lunch, repectively. Later that evening, while sitting and watching the Budweiser frogs on television, his cousin noticed that he started shaking in his chair. The cousin described staring, rhythmic jerking, the patient's eyes rolled up, and then foam began to come out of his mouth. He turned blue and stopped shaking. His cousin could not arouse him and noticed that his lap was wet. He was lethargic and slightly confused in the ER. The history was obtained from the patinet's cousin. The cousin related that the patient had a drinking problem which was exagerated by the end of the golf season. The patient had been drinking one to two cases of beer and one half to one full "fifth" of Sky Vodka each day for the last 25 years since his black Labrador Retriever named Rex had died. He had joined Alcoholics Anonymous 3 weeks before his admission and had begun to cut down his alcohol intake. In the ER, he gradually recovered full consciousness and became less confused. His neurological examination was abnormal because of absent ankle reflexes and diminished appreciation of all sensory modalities in a stocking glove distribution. His blood pressure was 190/80 and his pulse was 110. He was sweating despite a relatively cold ER Room. A CT scan of the head was normal.

Questions:

  1. What is the most likely diagnosis?

  2. What is the differential diagnoses (What are other causes of seizures in an alcoholic)?

  3. The patient is admitted to your service. What admitting orders would you write?

  4. What neruotrnsmitter receptor is thought to be involved in alcoholic withdrawal seizures?
Last updated by Webmaster on August 18, 2009

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